title: National surveillance of antimicrobial resistance among Gram-positive bacteria in Saudi Arabia.
abstract: BACKGROUND
  Antimicrobial-resistant Gram-positive bacteria are important causes of serious infections.
  
  
  METHODS
  Between January and December 2009, we examined clinical Gram-positive isolates from 24 hospitals across Saudi Arabia.
  
  
  RESULTS
  Among the 13750 isolates, Staphylococcus aureus (62.3%) was the commonest, followed by non-group A beta-haemolytic streptococci (14.8%), group A beta-haemolytic streptococci (7.1%), coagulase-negative staphylococci (6.6%), pneumococci (6.0%), and enterococci (3.1%). Resistance rates were high among S. aureus (methicillin-resistant S. aureus: 32%), coagulase-negative staphylococci (oxacillin: 63%) and pneumococci (penicillin G: 33%; erythromycin: 26%; ceftriaxone: 11%); low among enterococci (vancomycin: 1%) and among beta-haemolytic streptococci. Resistance rates varied between regions, but comparison was complicated by differences in antibiotics tested. Many relevant antibiotics were tested against few isolates (e.g. ampicillin, vancomycin, and high-level gentamicin versus enterococci) while unhelpful tests were widely performed (e.g. cefotaxime, ceftriaxone, and imipenem versus staphylococci.
  
  
  CONCLUSIONS
  Resistance is widespread in staphylococci and pneumococci, but not enterococci and beta-haemolytic streptococci in Saudi Arabia. Rationalization of antibiotic panels tested is urgently needed.
authors.forename: Atef M
authors.initials: AM
authors.lastname: Shibl
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Memish
authors.forename: Abdelmageed M
authors.initials: AM
authors.lastname: Kambal
authors.forename: Yazid A
authors.initials: YA
authors.lastname: Ohaly
authors.forename: Abdulrahman
authors.initials: A
authors.lastname: Ishaq
authors.forename: Abiola C
authors.initials: AC
authors.lastname: Senok
authors.forename: David M
authors.initials: DM
authors.lastname: Livermore
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D024881:Drug Resistance, Bacterial; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D008826:Microbial Sensitivity Tests; D011159:Population Surveillance; D012529:Saudi Arabia / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Enterococci,; MRSA,; Staphylococci,; Staphylococcus aureus,; Streptococci